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Introduction:We investigated long-term psychological distress among stroke family surrogate decision makers in Mexican Americans (MAs) and non-Hispanic Whites (NHWs).Methods:Ischemic and hemorrhagic stroke patients from the Brain Attack Surveillance in Corpus Christi (BASIC) project and their family surrogate decision makers from the Outcomes Among Surrogate Decision Makers in Stroke (OASIS) were enrolled. Family surrogates completed validated measures of post-traumatic stress (NSESSS), anxiety (GAD-7), and depression (PHQ-8) at discharge, 3, 6, and 12 months. Ethnic differences were assessed with multilevel linear mixed models, sequentially adjusted for pre-specified covariates as shown in the table.Results:There were 301 family surrogates for 241 stroke patients. MA patients were younger and less likely than NHWs to have died before the initial outcome interview (43% vs 56%, p=0.05), with no difference in baseline severity. MA family surrogates had lower educational attainment, income, and less use of advance care plans than NHWs. High scores on measures of psychological distress were common at all time points (Table). All psychological outcomes were worse among MAs on unadjusted analyses (Table). Symptoms of post-traumatic stress remained worse among MAs in the fully-adjusted model. Ethnic differences in anxiety were attenuated after adjustment for family demographics. Ethnic differences in depression were attenuated after adjustment for socioeconomic factors. Advance care plans were not associated with outcomes after accounting for other covariates and did not seem to confound any ethnic differences.Conclusions:Psychological distress is prevalent among family surrogate decision makers in the year after stroke and may be worse among MAs. Efforts are needed to support family members of all ethnic groups after severe strokes.

Our objective was to identify factors that contribute to or modify the sex difference in poststroke functional outcome.

Mexican Americans (MAs) were previously found to have lower mortality after ischemic stroke than non-Hispanic whites. We studied mortality trends in a population-based design.

The purpose of this statement is to delineate basic expectations regarding primary palliative care competencies and skills to be considered, learned, and practiced by providers and healthcare services across hospitals and community settings when caring for patients and families with stroke.

Decisions on life-sustaining treatments and the use of do-not-resuscitate (DNR) orders can affect early mortality after stroke. We investigated the variation in early DNR use after stroke among hospitals in California and the effect of this variation on mortality-based hospital classifications.

Objective:To explore ethnic differences in stroke patient surrogate decision makers’ (e.g. family) impressions of physician quality of communication (QOC) and shared decision making (SDM) in Mexican Americans (MAs) and non-Hispanic Whites (NHWs).Methods:Surrogate decision makers who discussed life-sustaining treatments for severe stroke patients (ischemic or intracerebral hemorrhage) from the Brain Attack Surveillance in Corpus Christi (BASIC) project completed validated measures of physician QOC (QOC-overall, QOC-general, and QOC-end-of-life) and SDM (collaboRATE). Regression models with Generalized Estimating Equations were used to investigate ethnic differences in outcome adjusted for pre-specified demographics, severity, mortality, and identified confounders.Results:From 4/2016 to 9/2020, 320 surrogates for 257 stroke cases were enrolled. Patient characteristics: median age 75 (IQR 64-87), female 52%, Race-ethnicity (MA 61%, NHW 33%, Other 5%), ICH 25%, median NIHSS 12 (IQR 5-20), deceased 45%. Surrogates had a median age of 57 (IQR 46-66) and were mostly female (77%). Compared to NHW surrogates, MA surrogates were more often women, had lower education, and less use of advance directives, but had more trust in physicians and were more likely to pray daily. Regression results for QOC are shown in the table. MA surrogates reported higher unadjusted scores for QOC-overall and QOC-end-of-life. These associations were stronger after adjustment for demographics, severity, and patient survival, though were no longer significant in the final fully adjusted models. A generally similar pattern was seen for SDM.Conclusions:MA surrogates tended to report better physician communication and more SDM than NHWs, though no difference was seen after adjustment for factors such as trust, daily prayer, or advance care planning. Further study of contributions to positive outcomes among diverse populations of stroke surrogates are warranted.

In a previous study, 0.3 and 0.45 mgkg of intravenous recombinant tissue plasminogen activator (rt-PA) were safe when combined with eptifibatide 75 mcgkg bolus and a 2-hour infusion (0.75 mcgkg per minute). The Combined Approach to Lysis Utilizing Eptifibatide and rt-PA in Acute Ischemic Stroke–Enhanced Regimen (CLEAR-ER) trial sought to determine the safety of a higher-dose regimen and to establish evidence for a phase III trial.

Hypertension is the most important risk factor associated with intracerebral hemorrhage. We explored racial differences in blood pressure (BP) control after intracerebral hemorrhage and assessed predictors of BP control at presentation, 30 days, and 1 year in a prospective cohort study.

We sought to describe the association of spirituality, optimism, fatalism, and depressive symptoms with initial stroke severity, stroke recurrence, and poststroke mortality.

Atrial fibrillation is a common cause of stroke with a known preventive treatment. We compared poststroke recurrence and survival in Mexican Americans (MAs) and non-Hispanic whites (NHWs) with atrial fibrillation in a population-based study.

Currently, a major focus on expanding acute ischemic stroke treatment opportunities centers on the development of drugs and devices with longer time windows for use. We sought to determine the time intervals within which stroke patients present to establish whether time window expansion will translate into more treatment.

We performed a pilot project to assess the need for and feasibility of a church-based stroke risk reduction intervention in a predominantly Mexican American community.